Under Oklahoma's new "in need of treatment" (INT) procedure, juvenile commitments have increased 10 times since 1983. About 8% of commitments are American Indian children. Generally, the mental health dilemma of Indian communities is characterized by multiple and interacting problems, acute symptoms masked by related problems such as alcoholism or delinquency, diagnoses complicated by different cultural values and symptom patterns, the pervasiveness of depression in Indian communities, and tendencies to experience psychological problems as physical illness. Studies suggest that Indian adolescents have more serious problems than youth of other races with respect to developmental disorders, post-traumatic stress disorder, identity disorder, depression, suicide, anxiety, substance abuse, and adjustment or behavior disorders. Environmental risk factors include otitis media, fetal alcohol syndrome, child abuse and neglect, parent alcoholism, and early death of parents. However, only 1-2% of the Indian Health Service budget goes to mental health services. When Indian children receive therapy, it may be based on white cultural assumptions that overlook cross-cultural value differences. Current INT programs threaten Indian communities in two major ways--by not meeting the treatment needs of Indian children, and by removing youth from Indian communities at an alarming rate. Sovereignty can provide a solution through enhanced enforcement of the Indian Child Welfare Act (recognition that INT procedures are in fact foster care placements), and through service agreements with state agencies to develop tribal mental health services and home-based care programs. (SV)